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COMPARATIVE STUDY
JOURNAL ARTICLE

[Treatment of intra-articular calcaneal fractures using Kirschner's wire or calcaneal plate]

Xuejin Li, Qun Li, Zhibo Zhang, Xiaoyan Wen, Hongjian Yan
Chinese Journal of Reparative and Reconstructive Surgery 2008, 22 (4): 459-62
18575449

OBJECTIVE: To compare the effect and syndrome of treating intra-articular calcaneal fractures using Kirschner's wire or AO calcaneal plate.

METHODS: From March 2003 to March 2006, 71 cases (86 feet) of intra-articular calcaneal fractures were treated with Kirschner's wire or AO calcaneal plate. Among them, 39 cases (48 feet) were treated using Kirschner's wire, male 34, female 5. The age ranged from 15 to 64 years old, 36 on average. The course of illness was from 4 hours to 10 days. There were 9 double side bone fractures and 30 one side bone fractures. Based on Sanders type, Type II were 40 feet, Type III were 7 feet and Type IV was 1 foot. The other 32 cases (38 feet) were treated using AO calcaneal plate, male 30, female 2. The age ranged from 18 to 55 years old, 33 on average. The course of illness was from 4 hours to 10 days. There were 6 double side bone fractures and 26 one side bone fractures. A total of 31 feet belonged to Sanders Type II, 5 to Type III, and 2 to Type IV. The 12-month follow-up, at least, was carried out in order to valuate the patients. The valuating items included: preoperative and postoperative Bohler's angle and Gissane's angle; heel bone height and width (contrast with the opposite side); to judge reposition circs by means of the CT scan and Borden's judgment; function valuation adopting the American Orthopedic Foot & Ankle Society (AOFAS) grade point system.

RESULTS: Patients with Kirschner's wire fixed were followed up for 12 to 48 months, and AOFAS score ranged from 75 to 100 points, 90.6 on average. The excellent and good rate was 87.8%. The preoperative Bohler's angle was from 0 to 10 degrees, 7.8 degrees on average, and postoperative from 30 to 40 degrees, 33.2 degrees on average. The preoperation Gissane's angle was 75 to 95 degrees, 84 degrees on average; and postoperative from 115 to 135 degrees, 125 degrees on average. There was significant difference (P < 0.05). The postoperative complications were that 1 foot was the incision edge shallow putrescence and 1 foot was the needle way infection. Patients with AO calcaneal plate fixed were followed up for 12 to 48 months, and AOFAS score was from 49 to 100 points, 87.5 on average. The excellent and good rate was 81.6%. There was no significant difference between the two groups (P > 0.05). The preoperative Bohler's angle ranged from 0 to 15 degrees, 6.5 degrees on average, and postoperative from 25 to 40 degrees, 30.2 degrees on average. The preoperative Gissare's angle was 72 to 92 degrees, 80 degrees on average; and postoperative from 115 to 1300,1200 on average. There was significant difference (P < 0.05). The postoperative complications were that 5 feet were the incision edge shallow putrescence, 1 was the common peroneal nerve hurt, and 1 was the petrous muscle aponeurotic inflammation.

CONCLUSION: There is no remarkable difference between the effects of treating intra-articular calcaneal fractures using plate or Kirschner's wire, but the treatment with Kirschner's wire is not only much easier and more economical, but has smaller wounds and fewer soft tissue problems.

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